No Cover Image

Journal article 21 views 6 downloads

Risk prediction of covid-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study / Julia Hippisley-Cox, Carol AC Coupland, Nisha Mehta, Ruth H Keogh, Karla Diaz-Ordaz, Kamlesh Khunti, Ronan Lyons, Frank Kee, Aziz Sheikh, Shamim Rahman, Jonathan Valabhji, Ewen M Harrison, Peter Sellen, Nazmus Haq, Malcolm G Semple, Peter W M Johnson, Andrew Hayward, Jonathan S Nguyen-Van-Tam

BMJ, Volume: 374, Start page: n2244

Swansea University Author: Ronan Lyons

  • 58431.pdf

    PDF | Version of Record

    This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license

    Download (664.78KB)

Check full text

DOI (Published version): 10.1136/bmj.n2244

Abstract

Objectives To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination.Design Prospective, population based cohort study using the QResearch database linked to data on covid-19...

Full description

Published in: BMJ
ISSN: 0959-8138 1756-1833
Published: BMJ 2021
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa58431
Tags: Add Tag
No Tags, Be the first to tag this record!
Abstract: Objectives To derive and validate risk prediction algorithms to estimate the risk of covid-19 related mortality and hospital admission in UK adults after one or two doses of covid-19 vaccination.Design Prospective, population based cohort study using the QResearch database linked to data on covid-19 vaccination, SARS-CoV-2 results, hospital admissions, systemic anticancer treatment, radiotherapy, and the national death and cancer registries.Settings Adults aged 19-100 years with one or two doses of covid-19 vaccination between 8 December 2020 and 15 June 2021.Main outcome measures Primary outcome was covid-19 related death. Secondary outcome was covid-19 related hospital admission. Outcomes were assessed from 14 days after each vaccination dose. Models were fitted in the derivation cohort to derive risk equations using a range of predictor variables. Performance was evaluated in a separate validation cohort of general practices.Results Of 6 952 440 vaccinated patients in the derivation cohort, 5 150 310 (74.1%) had two vaccine doses. Of 2031 covid-19 deaths and 1929 covid-19 hospital admissions, 81 deaths (4.0%) and 71 admissions (3.7%) occurred 14 days or more after the second vaccine dose. The risk algorithms included age, sex, ethnic origin, deprivation, body mass index, a range of comorbidities, and SARS-CoV-2 infection rate. Incidence of covid-19 mortality increased with age and deprivation, male sex, and Indian and Pakistani ethnic origin. Cause specific hazard ratios were highest for patients with Down’s syndrome (12.7-fold increase), kidney transplantation (8.1-fold), sickle cell disease (7.7-fold), care home residency (4.1-fold), chemotherapy (4.3-fold), HIV/AIDS (3.3-fold), liver cirrhosis (3.0-fold), neurological conditions (2.6-fold), recent bone marrow transplantation or a solid organ transplantation ever (2.5-fold), dementia (2.2-fold), and Parkinson’s disease (2.2-fold). Other conditions with increased risk (ranging from 1.2-fold to 2.0-fold increases) included chronic kidney disease, blood cancer, epilepsy, chronic obstructive pulmonary disease, coronary heart disease, stroke, atrial fibrillation, heart failure, thromboembolism, peripheral vascular disease, and type 2 diabetes. A similar pattern of associations was seen for covid-19 related hospital admissions. No evidence indicated that associations differed after the second dose, although absolute risks were reduced. The risk algorithm explained 74.1% (95% confidence interval 71.1% to 77.0%) of the variation in time to covid-19 death in the validation cohort. Discrimination was high, with a D statistic of 3.46 (95% confidence interval 3.19 to 3.73) and C statistic of 92.5. Performance was similar after each vaccine dose. In the top 5% of patients with the highest predicted covid-19 mortality risk, sensitivity for identifying covid-19 deaths within 70 days was 78.7%.Conclusion This population based risk algorithm performed well showing high levels of discrimination for identifying those patients at highest risk of covid-19 related death and hospital admission after vaccination.
Item Description: This article has a correction. Please see: https://doi.org/10.1136/bmj.n2300
Keywords: Humans, Vaccination, Hospitalization, Risk Assessment, Prospective Studies, Comorbidity, Databases, Factual, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, United Kingdom, COVID-19, SARS-CoV-2, COVID-19 Vaccines
College: Swansea University Medical School
Funders: National Institute for Health Research (NIHR)
Start Page: n2244